FtM Breast Reduction from DD cup to B? A? Goal is to preserve erotic nipple sensation with the smallest breasts. (Photo)

In an ideal surgery, the two major goals would be to make the chest as contoured/flat as possible (with the least obvious scars) and to preserve nipple sensation.  These two goals sometimes are at conflict with each other since the nerves to the nipple run through the breast tissue directly up to the nipple.  You have both excess skin with significant ptosis as well as increased breast size.  The best technique for "flatness" would be excision with free nipple grafting, however you would lose sensation with this option.  The other option would be to try to maintain the nerve supply by leaving a "pedicle" of breast tissue, however there is still a significant risk of sensation loss with this technique.  Liposuction with staged skin resection in the future (second surgery) could be considered as well and may lead to a higher rate of continued sensation, but there is still a risk of some sensory changes.  The most important thing is to find a surgeon with experience with this procedure and to convey that nipple sensation is important to you (there will be a trade off between contour and sensation)

Top Surgery is the #reduction and masculinization of the breasts and chest for a person who wants a more #masculine chest.  This is often an individual who desires #gender reassignment. Breast tissue is #removed and the #nipple position is usually made smaller and then placed in a more masculine #anatomic #position.  It's best to begin seeking a plastic surgeon with #board #certification and experience in this type of procedure. You should feel comfortable with your surgeon and his or her office staff. They should be open-minded regarding gender surgery. It’s important for your surgeon to have an aesthetic eye for body contouring, you should be comfortable with the surgical facility that your doctor uses and it should be certified. There are several methods used which depend upon the patient’s breast or chest #size before surgery. Considerations include the #laxity of skin, the #size of the #areola, the amount of #fat and recent weight #gain or weight #loss. The most common procedures which are described include the #periareola, #buttonhole, #double incision, and #anchor patterns. I often use #liposuction along with the double #incision for larger breasts, and, some variation for smaller breasts; depending upon the position of the areola. The female breast nipple and areola are often centered on the breast. However, the nipple and areola are lower and closer to the outside edge of the #pectoralis muscle in the male patient. Shaping the side of the chest may also be required and can be performed with #suctioning; along with contouring of the muscle, as noted above, to provide the best definition for the chest. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

I will be very honest, you have large breasts.  It is very difficult to make your chest look masculine, and try and maintain nipple sensation.  For someone your size, I would routinely do a free nipple graft technique. With this technique you will lose sensation.  If you try and keep the nipple sensation intact, then you will limit making your chest size small enough.  If you do a breast reduction, down to a smaller size you will still have a larger breast that will look more feminine.